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Toxic Shock Syndrome (TSS)

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a cluster of symptoms that involve many systems of the body. Certain bacterial infections release toxins into the bloodstream. These toxins can spread to many body organs. This can cause severe damage and illness.

What causes toxic shock syndrome?

The bacteria listed below commonly cause TSS.

Staphylococcus aureus (S. aureus)

These bacteria may normally exist on the surface of a person's body and may not cause infection. But if there is a cut, burn, or other injury, they may enter the wound and cause a localized or spreading infection. The germ may make a toxin in the bloodstream. Certain strains of S. aureus are more likely than others to cause skin and spreading infections. And a person can pick up a new, more dangerous strain. S. aureus strains can be spread by direct contact with infected people, clothes, or objects in the environment. TSS from S. aureus was identified in the late 1970s and early 1980s when menstruating women used highly absorbent tampons. Because of changes in how tampons are made, this type of TSS has declined.

Streptococcus pyogenes (S. pyogenes)

TSS from S. pyogenes is most commonly seen in children and older adults. This type of TSS may happen from a cut, injury, or other localized infection. It also can occur as a secondary infection, such as in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), or have a weak immune system. Other people at risk are those with diabetes, chronic lung disease, or heart disease.

Clostridium sordellii (C. sordellii)

These bacteria normally exist in the vagina and don't cause infection. They may enter the uterus during normal menstruation, childbirth, or gynecological procedures, such as abortion. Intravenous drug use can also cause C. sordellii infections.

Who is at risk for toxic shock syndrome?

You may be at risk for TSS if you:

Used super-absorbent tampons in the past

Have surgical wounds

Have a local infection in the skin or deep tissue

Used intravenous drugs in the past

Have recently given birth or have had a miscarriage or abortion

What are the symptoms of toxic shock syndrome?

Symptoms of TSS involve many systems. They may look like other infections. While each person may have different symptoms, these are the most common ones:

Fever higher than 102°F (38.9°C)

Chills

Red eyes (conjunctivitis)

Headache

Fatigue

Rash that is red and flat and that covers most of the body

Shedding of the skin in large sheets, especially over the palms and soles, which is seen 1 to 2 weeks after the onset of symptoms

Low blood pressure

Vomiting

Diarrhea

Severe muscle aches and pain

Increased blood flow to the mouth, eyes, and vagina, making them appear red

Decreased urine output and sediment in urine

Decreased liver function

Bruising due to low blood platelet count

Disorientation and confusion

High white blood cell count in the blood

How is toxic shock syndrome diagnosed?

Ruling out similar illnesses (such as Rocky Mountain spotted fever) is critical in diagnosing TSS. Tests you may need are:

Blood and wound cultures. These tests find and identify microorganisms.